CA2223990C - Guiding catheter for coronary sinus - Google Patents
Guiding catheter for coronary sinus Download PDFInfo
- Publication number
- CA2223990C CA2223990C CA002223990A CA2223990A CA2223990C CA 2223990 C CA2223990 C CA 2223990C CA 002223990 A CA002223990 A CA 002223990A CA 2223990 A CA2223990 A CA 2223990A CA 2223990 C CA2223990 C CA 2223990C
- Authority
- CA
- Canada
- Prior art keywords
- distal
- guiding catheter
- proximal
- section
- shaft
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M29/00—Dilators with or without means for introducing media, e.g. remedies
- A61M29/02—Dilators made of swellable material
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/0043—Catheters; Hollow probes characterised by structural features
- A61M25/0054—Catheters; Hollow probes characterised by structural features with regions for increasing flexibility
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
- A61M25/008—Strength or flexibility characteristics of the catheter tip
- A61M2025/0081—Soft tip
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/1052—Balloon catheters with special features or adapted for special applications for temporarily occluding a vessel for isolating a sector
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2210/00—Anatomical parts of the body
- A61M2210/12—Blood circulatory system
- A61M2210/125—Heart
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
- A61M25/0041—Catheters; Hollow probes characterised by the form of the tubing pre-formed, e.g. specially adapted to fit with the anatomy of body channels
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
- A61M25/0133—Tip steering devices
- A61M25/0141—Tip steering devices having flexible regions as a result of using materials with different mechanical properties
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
- A61M25/0133—Tip steering devices
- A61M25/0152—Tip steering devices with pre-shaped mechanisms, e.g. pre-shaped stylets or pre-shaped outer tubes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/06—Body-piercing guide needles or the like
- A61M25/0662—Guide tubes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/056—Transvascular endocardial electrode systems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/056—Transvascular endocardial electrode systems
- A61N1/057—Anchoring means; Means for fixing the head inside the heart
Abstract
A guiding catheter for delivery of intravascular devices to a patient's coronary sinus. The guiding catheter has a relatively stiff proximal section and a relatively flexible distal section, the latter being about 1 to about 6 inches in length and being configured to subselect a branch cardiac vein leading to the coronary sinus. The guiding catheter is particularly suitable for delivering an intravascular device for sensing electrical activity into a cardiac vein to detect such activity from within the blood vessel.
Description
GUIDING CATHETER FOR CORONARY SINUS
BACKGROUND OF THE INVENTION
This invention generally relates to a guiding catheter for the direction of an intravascular device into a patient's coronary sinus and particularly to the direction of a mapping device into a cardiac vein draining into the coronary sinus for detecting electrical activity or signals causing or involved with arrhythmia from within the cardiac vein.
One of the most frequently used treatment modalities for arrhythmia is to destroy or damage heart tissue which causes the to arrhythmia or involved with the arrhythmia by suitably heating the tissue, e.g. applying a laser beam or high frequency electrical energy (RF or microwave).
To be effective, the location of the tissue site causing or involved with 'the arrhythmia must be accurately determined in order to be s5 able to contact a heart surface adjacent to the desired location with a tissue destroying device. A major problem of ablating the site of the origin of the signals or a conductive pathway with commercially available devices is that an excessive amount of good tissue is very frequently damaged or destroyed along with the arrhythmogenic site to ensure that 2o the arrhythmia does not return. For example, the average arrhythmogenic site consists of about 1.4 cm2 of endocardial tissue, whereas a re-entrant WO 9b/4'03Q2 PC'T/U596/d~283 site might be much larger. RF ablation techniques with commerCia!!y , , . ;
available devices produce lesions about 0.5 cmz in diameter, ,so that it rnay be necessary to form several overlapping lesions in the regipn in , r ordEr to completely ablate the area of interest and termination of the arrhythmia. If the arrhythmogenic or re-entrant site has not been , accurately mapped, much good tissue surrounding the sJt~e will be' ' , unnecessarily damaged ar destroyed to ensure termination of the , arrhythmia. ' .
'i A variety of methods have been used to detect electrPcal ~ , ' ~o activity within a patient's heart to facilitate the mapping of electrical , activity causing the arrhythmia. A number of U.S. patents describe the ., .
use of elongated intravascular signal sensing devices which are ac~vance~d through the patient's vascuiature until the distal portions of the sensing ~ , devices are disposed within a patient's hears chamber with one ar, more ~.5 electrodes vn the distal portion of the sensing device in contact with the , , , ,; endacardial lining. While this procedure is widely used, it does not ;
always allow the site of arrhythmogenic signals to be accurately . , . " determined and frequently results in unnecessary damage to heart.tissue , ' ' which may already be in jeopardy. ~ ~, ' 20 Capending application CA 2,15~,Tf3 ; . , .
entitled INTRAVASCIJLAR SEN51NG DEVIGE describe$ , ' ' intravascula~r devices which can be advanced into a patient's ~coroi~ary , artery or cardiac vein where the device is used to detect electrical-.activity ~ . ' of the patient's heart. , 2g While there are commercially available guidJng'cathetprs ' .
suitable for directing a variety of intravascular devices into a~ patient's . coronary arteries, there are no devices available which allow fvr th~ rapid ' ' advancement of an intravascular device into a patient's coronary sinus '~
and particularly into a cardiac vein draining into the coronary sinus. ' ~ , , ', i.
,y , ' , ' .' . ' ' ~ I' , , n n " , '. ' r .
, 'y.
, , ~ , w,.-.,.~".. ... --_....... , ._ ...~__ . _ _. ~~ , , "C
wo 9siao34z rc~rrt~sgrre, ,:. , , " . ' '~UMMAI~Y OF TWF PNVEIwITf~IV . ~ , ' , ,.
.. ,3..
' The present inventicn is directed to a gui~ting catheter which . , ', ~,» is configured to be advanced through the patient's peripheral vascular . ' r system, through the right atrium and into the coronary sinus ,through the ~~
~ ' s coronary sinus cerium. Within the coronary sinus tire distal end of the I , , .;
guiding Catheter is used to subselect and enter a branch vein leading toward the coronary sinus, -The guiding catheter of the invention has a ralatlvely stiff ' proximal shaft soCtion and a relatively flexible distal shaft section which is, .
.
~o at least in part shaped cr is shapaable to a shape suitable for advancement within the patient's coronary sinus and particutariy a branch ~ ' ' vein thereof. The distal shaft section prsterably has a proximal portion w ' > , which has a flexibility Qreater than that of the proximal shaft section and -v a distal portion which has a flexibility greater than that of the proximal is portion of the distal shaft section. An inner lumen extends within the , ' catheter shaft to and in fluid communication with a port in the di~~tai:end , ~ ' thereof. An intermediate shaft section may be disposed between the w ' .' ~ proximal and distal shaft sections and have a flexibility intermediate that , of the proximal and distal shaft sections. ~ ' ~o Tha proximal shaft section is preferably formed of polymer ~, ' material having a durometer hardness of about 60D to about 901 (Shore), the proximal portion of the distal shaft section a prt~lymer mat$rial having .' a durameter hardness of about 30D to about SOD (Shore) and the t~istal ' 1.
portion of the distal shaft section a polymer material having a durometer . 1 25 hardness of about 80A to about 20D (Shore). A s4itabl~ material for the ~ .;
proximal shaft section is Pebax*7233 (available from AtoChem), a suitable material for the proximal portion of the distal shaft section a suitable ~, ' material is pebaX 8533 tsiso available from Atochem) and a suitabi~ . , material for the distal portion of the distal shaft section is Tecothan~ , 30 (available from 'fhermedics, Ins. : , i, ~ ' ;. . , . ~ . . ..
. .
_ . .
*-trademark ,~ .
Y ~~ v.
l ~ . . , . ~ n . , , ' v., , ~ L , .. ., . ~ _ ' The length of the distal shaft section is about 2 to about 7 cm, preferably about 3 to about 6 cm to ensure that the distal end of the catheter shaft seats well into the desired vein branching off from the coronary sinus. The overall length of the catheter shaft is about 25 to A
about 75 cm.
In one presently preferred procedure the catheter is introduced into the patient's venous system, e.g the femoral vein, by conventional Seldinger techniques and advanced through the patient's vasculature into the right atrium. The proximal end of the catheter shaft of extending out of the patient is torqued to guide the distal end of the catheter through the coronary sinus ostium into the coronary sinus. With the distal end of the catheter within the coronary sinus, the catheter is advanced and further torqued to direct its distal end into a desired branch vein which drains into the coronary sinus. Alternatively, the catheter can be advanced over a guidewire which is slidably disposed at the inner lumen thereof with the distal extremity of the guidewire being disposed within the desired location within the patient's coronary sinus or branch vein. However, in this latter instance the catheter shaft need not be torquable but it must have sufficient pushability to be advanced over the 2o guidewire.
When the guiding catheter of the present invention is properly positioned within the patient's coronary sinus with its distal extremity seated within the desired branch vein which drains into the coronary sinus, an intravascular device having sensing electrodes on the distal extremity thereof may be advanced through the inner lumen of the guiding catheter into the branch vein. The intravascular device is advanced through the branch vein until the sensing electrodes on its distal end are positioned at a desired location within a branch vein beyond the distal end of the guiding catheter. Electrical activity, such as electrical , 3 o activity causing or involved with arrhythmia, may be detected by the sensing electrodes and the activity sensed is converted to signals which are used to develop a visual representation of the electrical activity. The a . ;' ., ' VVO 9d/4034= PCTIUS9d/Q9ZS3 position of the intravasculer device within the blood v~ssel may bp.
' adjusted to more accurately determine the source of the electrical activity.
r pnce the region of the patient's hgart causing or involved. with the arrhythmia is located, an ablation device may be introduced to ablate the tissue involved with or causing the arrhythmia and thereby terminate the v arrhythmia. For further details of intravascular devices far detecting .
electrical activity and for ablating or lysing tissue causing or involved with ° , the electrical activity, reference is made to copending applications , .. CA 2,7,54;772 and CA 2,154,773. , .' . ~ r ~ .., ~ , . ...~--,.._._..._.. .... ., ~ . , _ ' . ~ ,.i,; ~'..
v;' ~ . ', , . _ _ . , , - . , . . ' , .
. ~ ~ ~ _ P~~fer~trry,, , w ~~, .~ ';.
i . ,.. ,. n ~, ~J
the Intravascular sensing device used to detect electri~Cai activity,atso Y~a~s ~~ r :,~,,: ;, . , means to ablate or otherwise I s . : . . .
... , y a the tissue causing or involved !uva#h the rx ;:~:w . electrical acrimty. ' ..
~5 In one presently preferred embodiment of the inventior<, th'e " ; : ' catheter is provided with an inflatable balloon on its distal extremity to stop blood flow through the blood vessel in order to minimize mistiirsction ,' ' ' of the contrast fluid and the dilution th~rsof which can interfere v'srtth fluoroscopic observation of the branch blood vessel.
ZD These and other advantages of the invention will bepome '~ , , more apparent from the following detailed description of the, invention , ~ , when~taken in conjunction with the accompanying exemplary dralysrings. " ' ' , y BpIEF DE~GpIPT~ON OF, .THE bRAW1111OS ~. , ,.
Fg. 1 is an elevational view, partially in sectfon~, of a: guiding J' , i.
25 catheter embodying features of the lnvBntlon.
~s ; .
' Fig. 2 is a transverse crass-sectional view of ~h~ catheter ' ; , shown in Fig. 1 taken along the Ilnes 2-2.
Fig. 3 is an elevatlonal view of a patient's heart, with';portions "~ 1 v of the heart wall removed to show the right atrium and coronary sinus , , ' 30 ' astium thereof. ~ , ' ..a :. ~ , "
".;
4 , ,L'% ' ;:' S ~ , . %~4 I
i~d n ~, . . 1 r. ' ..
.._. . .. . -_. ~ .
i~~ n . . .
Fig. 4 is an elevational view, partially in section, of an alternative embodiment wherein an occluding member is provided on the distal extremity of the catheter.
Fig. 5 is a transverse cross-sectional view of the catheter , shown in Fig. 4 taken along the lines 5-5.
Fig. 6 is a transverse cross-sectional view of an alternative catheter shaft in which reinforcement is incorporated to provide a more torquable shaft.
Fig. 7 is a cross sectional view of a patient's coronary sinus 1o with the catheter shown in Fig. 1 disposed within the coronary sinus with the balloon inflated to occlude the sinus and with the distal end of the catheter disposed within a branch vein leading to the sinus.
Figs. 8-1 1 are schematic views of a variety of conventional shapes into which the distal extremity of the catheter may be formed.
DETAILED DESCRIPTION OF THE INVENTION
As shown in Figs.1 and 2 the catheter 10 of the invention generally includes an elongated shaft 1 1, a distal shaft section 12, a proximal shaft section 13, an inner lumen 14 and an adapter 15 on the proximal end of the shaft 11. A port 16 is provided in the distal end of 2 o the catheter shaft 1 1 which is in fluid communication with the inner lumen 14. The distal shaft section 12 includes a proximal portion 17 and a distal portion 18.
Fig. 3 illustrates the catheter 10 shown in Fig. 1 disposed within the patient's vascular system with the distal section 12 of the catheter seated within the patient's coronary sinus ostium 19. In this embodiment, the catheter 10 has been introduced from the femoral vein (not shown) and advanced through the inferior vena cava 20 and into the right atrium 21.
An alternative embodiment of the invention is depicted in 3o Figs. 4 and 5. In this embodiment, the catheter 30 generally includes an ' elongated catheter shaft 31, a distal shaft section 32, a proximal shaft WO 9dJ4034Z 1'CT'IUS961B'9283 " s9ction 33, an inner lumen 34, a multiarm adapter 35'on thie'prnxtmal grid ' A ~ . . . , df the shaft 31 and an occlusion balloon 36 on the distal extremity of the shaft 31. A port 37 is provided in the distal end of the Catheter shaft 3~1 ~
' which is In fluid communication with the inner lumen 34. The Catheter s shaft 31 is provided with a second inner lumen 40 which extends through the shaft 31 tv the interior of the balloon 3B to direct inflation fluid ~ r , ' therein. The side arm 41 of adapter 3$ facilitates introduction of ~Irtflation fluid into the second inner lumen 40, The center arm 42 of the adapter' .
35 allows for the introduction of a guidewire or catheter or, pantrast fluid , 7.o into the inner lumen 34.
Fig. B illustrates the dist2~l extremity of the catheter ~Q , shown In Figs, 4 and 5 disposed within a patient's coronary sinus~5'0 with "
the distal tip 51 thereof seated within a branch vein 52 leading to'the coronary sinus. "fhe balloon 3B is shpwn in an inflated condition which ' 15 occludes the passageway of the sinus 50. The balloon ~6 may be formed " ' of inelastic or elastic polymer materials. A presently preferred balloon. ' which is formed of polyurethane IPellathane-80 A durometerE~ is available from World Medical of Miami. FL. Typically, the balloon has an 1_C~,.of , about 7F, and inflated diameter vt about 8-13 mm and a lengrth of ,abQUt , ao 9 mm. " ' ° ' Y, ' ~ An alternative embodiment is shown in Fig, 7 wherelrr the, praximel portion of the catheter shaft 60 is has braided feinforcemBnt $'f , to provide increased torquability. This embodiment may ats~o havs.a. first lumen 62 and a second inner lumen 63, which correspond to the inner , , 2s lumens 34 and 40 respectively of the embodiment shown irt Figs. 4 and , 5. . . , Figs. 8-91 illustrate various Conventional shapes far the' , distal extremity df the guiding catheter of the invention. The shape shown in Fig. ~ is commonly called a Josephson type curve, Fig. 9 ° , 3o represents a Darnato type curve, Fig. 10 a EI Gamal type curve and Fig, "
'' T t a hockey stick type curve. Tha proximal. Intermediate and distil shaft , y , saations are as indicated. Th$ distil extremi#I$$ of ,~~h~ , ~ "
. ' , , :c catheters may be shaped before insertion into the patient's body by heating the catheter with a mandrel of the desired shape disposed within the inner lumen of the distal extremity so that the distal extremity will keep the shape of the mandrel when the catheter is cooled. If desired, control lines (not shown) may be incorporated into the wall of the catheter and extend out the proximal end of the catheter shaft, whereby when tension is applied thereto after the catheter is inserted into the patient, the distal extremity of the catheter shaft is deflected or shaped in a desired manner. These drawings are provided with reference numbers to as in Figs. 1 and 2.
Although individual features of embodiments of the invention may be shown in some of the drawings and not in others, those skilled in the art will recognize that individual features of one embodiment of the invention can be combined with any or all the features of another embodiment. Various modifications and improvements may be made to the present invention without departing from the scope thereof.
BACKGROUND OF THE INVENTION
This invention generally relates to a guiding catheter for the direction of an intravascular device into a patient's coronary sinus and particularly to the direction of a mapping device into a cardiac vein draining into the coronary sinus for detecting electrical activity or signals causing or involved with arrhythmia from within the cardiac vein.
One of the most frequently used treatment modalities for arrhythmia is to destroy or damage heart tissue which causes the to arrhythmia or involved with the arrhythmia by suitably heating the tissue, e.g. applying a laser beam or high frequency electrical energy (RF or microwave).
To be effective, the location of the tissue site causing or involved with 'the arrhythmia must be accurately determined in order to be s5 able to contact a heart surface adjacent to the desired location with a tissue destroying device. A major problem of ablating the site of the origin of the signals or a conductive pathway with commercially available devices is that an excessive amount of good tissue is very frequently damaged or destroyed along with the arrhythmogenic site to ensure that 2o the arrhythmia does not return. For example, the average arrhythmogenic site consists of about 1.4 cm2 of endocardial tissue, whereas a re-entrant WO 9b/4'03Q2 PC'T/U596/d~283 site might be much larger. RF ablation techniques with commerCia!!y , , . ;
available devices produce lesions about 0.5 cmz in diameter, ,so that it rnay be necessary to form several overlapping lesions in the regipn in , r ordEr to completely ablate the area of interest and termination of the arrhythmia. If the arrhythmogenic or re-entrant site has not been , accurately mapped, much good tissue surrounding the sJt~e will be' ' , unnecessarily damaged ar destroyed to ensure termination of the , arrhythmia. ' .
'i A variety of methods have been used to detect electrPcal ~ , ' ~o activity within a patient's heart to facilitate the mapping of electrical , activity causing the arrhythmia. A number of U.S. patents describe the ., .
use of elongated intravascular signal sensing devices which are ac~vance~d through the patient's vascuiature until the distal portions of the sensing ~ , devices are disposed within a patient's hears chamber with one ar, more ~.5 electrodes vn the distal portion of the sensing device in contact with the , , , ,; endacardial lining. While this procedure is widely used, it does not ;
always allow the site of arrhythmogenic signals to be accurately . , . " determined and frequently results in unnecessary damage to heart.tissue , ' ' which may already be in jeopardy. ~ ~, ' 20 Capending application CA 2,15~,Tf3 ; . , .
entitled INTRAVASCIJLAR SEN51NG DEVIGE describe$ , ' ' intravascula~r devices which can be advanced into a patient's ~coroi~ary , artery or cardiac vein where the device is used to detect electrical-.activity ~ . ' of the patient's heart. , 2g While there are commercially available guidJng'cathetprs ' .
suitable for directing a variety of intravascular devices into a~ patient's . coronary arteries, there are no devices available which allow fvr th~ rapid ' ' advancement of an intravascular device into a patient's coronary sinus '~
and particularly into a cardiac vein draining into the coronary sinus. ' ~ , , ', i.
,y , ' , ' .' . ' ' ~ I' , , n n " , '. ' r .
, 'y.
, , ~ , w,.-.,.~".. ... --_....... , ._ ...~__ . _ _. ~~ , , "C
wo 9siao34z rc~rrt~sgrre, ,:. , , " . ' '~UMMAI~Y OF TWF PNVEIwITf~IV . ~ , ' , ,.
.. ,3..
' The present inventicn is directed to a gui~ting catheter which . , ', ~,» is configured to be advanced through the patient's peripheral vascular . ' r system, through the right atrium and into the coronary sinus ,through the ~~
~ ' s coronary sinus cerium. Within the coronary sinus tire distal end of the I , , .;
guiding Catheter is used to subselect and enter a branch vein leading toward the coronary sinus, -The guiding catheter of the invention has a ralatlvely stiff ' proximal shaft soCtion and a relatively flexible distal shaft section which is, .
.
~o at least in part shaped cr is shapaable to a shape suitable for advancement within the patient's coronary sinus and particutariy a branch ~ ' ' vein thereof. The distal shaft section prsterably has a proximal portion w ' > , which has a flexibility Qreater than that of the proximal shaft section and -v a distal portion which has a flexibility greater than that of the proximal is portion of the distal shaft section. An inner lumen extends within the , ' catheter shaft to and in fluid communication with a port in the di~~tai:end , ~ ' thereof. An intermediate shaft section may be disposed between the w ' .' ~ proximal and distal shaft sections and have a flexibility intermediate that , of the proximal and distal shaft sections. ~ ' ~o Tha proximal shaft section is preferably formed of polymer ~, ' material having a durometer hardness of about 60D to about 901 (Shore), the proximal portion of the distal shaft section a prt~lymer mat$rial having .' a durameter hardness of about 30D to about SOD (Shore) and the t~istal ' 1.
portion of the distal shaft section a polymer material having a durometer . 1 25 hardness of about 80A to about 20D (Shore). A s4itabl~ material for the ~ .;
proximal shaft section is Pebax*7233 (available from AtoChem), a suitable material for the proximal portion of the distal shaft section a suitable ~, ' material is pebaX 8533 tsiso available from Atochem) and a suitabi~ . , material for the distal portion of the distal shaft section is Tecothan~ , 30 (available from 'fhermedics, Ins. : , i, ~ ' ;. . , . ~ . . ..
. .
_ . .
*-trademark ,~ .
Y ~~ v.
l ~ . . , . ~ n . , , ' v., , ~ L , .. ., . ~ _ ' The length of the distal shaft section is about 2 to about 7 cm, preferably about 3 to about 6 cm to ensure that the distal end of the catheter shaft seats well into the desired vein branching off from the coronary sinus. The overall length of the catheter shaft is about 25 to A
about 75 cm.
In one presently preferred procedure the catheter is introduced into the patient's venous system, e.g the femoral vein, by conventional Seldinger techniques and advanced through the patient's vasculature into the right atrium. The proximal end of the catheter shaft of extending out of the patient is torqued to guide the distal end of the catheter through the coronary sinus ostium into the coronary sinus. With the distal end of the catheter within the coronary sinus, the catheter is advanced and further torqued to direct its distal end into a desired branch vein which drains into the coronary sinus. Alternatively, the catheter can be advanced over a guidewire which is slidably disposed at the inner lumen thereof with the distal extremity of the guidewire being disposed within the desired location within the patient's coronary sinus or branch vein. However, in this latter instance the catheter shaft need not be torquable but it must have sufficient pushability to be advanced over the 2o guidewire.
When the guiding catheter of the present invention is properly positioned within the patient's coronary sinus with its distal extremity seated within the desired branch vein which drains into the coronary sinus, an intravascular device having sensing electrodes on the distal extremity thereof may be advanced through the inner lumen of the guiding catheter into the branch vein. The intravascular device is advanced through the branch vein until the sensing electrodes on its distal end are positioned at a desired location within a branch vein beyond the distal end of the guiding catheter. Electrical activity, such as electrical , 3 o activity causing or involved with arrhythmia, may be detected by the sensing electrodes and the activity sensed is converted to signals which are used to develop a visual representation of the electrical activity. The a . ;' ., ' VVO 9d/4034= PCTIUS9d/Q9ZS3 position of the intravasculer device within the blood v~ssel may bp.
' adjusted to more accurately determine the source of the electrical activity.
r pnce the region of the patient's hgart causing or involved. with the arrhythmia is located, an ablation device may be introduced to ablate the tissue involved with or causing the arrhythmia and thereby terminate the v arrhythmia. For further details of intravascular devices far detecting .
electrical activity and for ablating or lysing tissue causing or involved with ° , the electrical activity, reference is made to copending applications , .. CA 2,7,54;772 and CA 2,154,773. , .' . ~ r ~ .., ~ , . ...~--,.._._..._.. .... ., ~ . , _ ' . ~ ,.i,; ~'..
v;' ~ . ', , . _ _ . , , - . , . . ' , .
. ~ ~ ~ _ P~~fer~trry,, , w ~~, .~ ';.
i . ,.. ,. n ~, ~J
the Intravascular sensing device used to detect electri~Cai activity,atso Y~a~s ~~ r :,~,,: ;, . , means to ablate or otherwise I s . : . . .
... , y a the tissue causing or involved !uva#h the rx ;:~:w . electrical acrimty. ' ..
~5 In one presently preferred embodiment of the inventior<, th'e " ; : ' catheter is provided with an inflatable balloon on its distal extremity to stop blood flow through the blood vessel in order to minimize mistiirsction ,' ' ' of the contrast fluid and the dilution th~rsof which can interfere v'srtth fluoroscopic observation of the branch blood vessel.
ZD These and other advantages of the invention will bepome '~ , , more apparent from the following detailed description of the, invention , ~ , when~taken in conjunction with the accompanying exemplary dralysrings. " ' ' , y BpIEF DE~GpIPT~ON OF, .THE bRAW1111OS ~. , ,.
Fg. 1 is an elevational view, partially in sectfon~, of a: guiding J' , i.
25 catheter embodying features of the lnvBntlon.
~s ; .
' Fig. 2 is a transverse crass-sectional view of ~h~ catheter ' ; , shown in Fig. 1 taken along the Ilnes 2-2.
Fig. 3 is an elevatlonal view of a patient's heart, with';portions "~ 1 v of the heart wall removed to show the right atrium and coronary sinus , , ' 30 ' astium thereof. ~ , ' ..a :. ~ , "
".;
4 , ,L'% ' ;:' S ~ , . %~4 I
i~d n ~, . . 1 r. ' ..
.._. . .. . -_. ~ .
i~~ n . . .
Fig. 4 is an elevational view, partially in section, of an alternative embodiment wherein an occluding member is provided on the distal extremity of the catheter.
Fig. 5 is a transverse cross-sectional view of the catheter , shown in Fig. 4 taken along the lines 5-5.
Fig. 6 is a transverse cross-sectional view of an alternative catheter shaft in which reinforcement is incorporated to provide a more torquable shaft.
Fig. 7 is a cross sectional view of a patient's coronary sinus 1o with the catheter shown in Fig. 1 disposed within the coronary sinus with the balloon inflated to occlude the sinus and with the distal end of the catheter disposed within a branch vein leading to the sinus.
Figs. 8-1 1 are schematic views of a variety of conventional shapes into which the distal extremity of the catheter may be formed.
DETAILED DESCRIPTION OF THE INVENTION
As shown in Figs.1 and 2 the catheter 10 of the invention generally includes an elongated shaft 1 1, a distal shaft section 12, a proximal shaft section 13, an inner lumen 14 and an adapter 15 on the proximal end of the shaft 11. A port 16 is provided in the distal end of 2 o the catheter shaft 1 1 which is in fluid communication with the inner lumen 14. The distal shaft section 12 includes a proximal portion 17 and a distal portion 18.
Fig. 3 illustrates the catheter 10 shown in Fig. 1 disposed within the patient's vascular system with the distal section 12 of the catheter seated within the patient's coronary sinus ostium 19. In this embodiment, the catheter 10 has been introduced from the femoral vein (not shown) and advanced through the inferior vena cava 20 and into the right atrium 21.
An alternative embodiment of the invention is depicted in 3o Figs. 4 and 5. In this embodiment, the catheter 30 generally includes an ' elongated catheter shaft 31, a distal shaft section 32, a proximal shaft WO 9dJ4034Z 1'CT'IUS961B'9283 " s9ction 33, an inner lumen 34, a multiarm adapter 35'on thie'prnxtmal grid ' A ~ . . . , df the shaft 31 and an occlusion balloon 36 on the distal extremity of the shaft 31. A port 37 is provided in the distal end of the Catheter shaft 3~1 ~
' which is In fluid communication with the inner lumen 34. The Catheter s shaft 31 is provided with a second inner lumen 40 which extends through the shaft 31 tv the interior of the balloon 3B to direct inflation fluid ~ r , ' therein. The side arm 41 of adapter 3$ facilitates introduction of ~Irtflation fluid into the second inner lumen 40, The center arm 42 of the adapter' .
35 allows for the introduction of a guidewire or catheter or, pantrast fluid , 7.o into the inner lumen 34.
Fig. B illustrates the dist2~l extremity of the catheter ~Q , shown In Figs, 4 and 5 disposed within a patient's coronary sinus~5'0 with "
the distal tip 51 thereof seated within a branch vein 52 leading to'the coronary sinus. "fhe balloon 3B is shpwn in an inflated condition which ' 15 occludes the passageway of the sinus 50. The balloon ~6 may be formed " ' of inelastic or elastic polymer materials. A presently preferred balloon. ' which is formed of polyurethane IPellathane-80 A durometerE~ is available from World Medical of Miami. FL. Typically, the balloon has an 1_C~,.of , about 7F, and inflated diameter vt about 8-13 mm and a lengrth of ,abQUt , ao 9 mm. " ' ° ' Y, ' ~ An alternative embodiment is shown in Fig, 7 wherelrr the, praximel portion of the catheter shaft 60 is has braided feinforcemBnt $'f , to provide increased torquability. This embodiment may ats~o havs.a. first lumen 62 and a second inner lumen 63, which correspond to the inner , , 2s lumens 34 and 40 respectively of the embodiment shown irt Figs. 4 and , 5. . . , Figs. 8-91 illustrate various Conventional shapes far the' , distal extremity df the guiding catheter of the invention. The shape shown in Fig. ~ is commonly called a Josephson type curve, Fig. 9 ° , 3o represents a Darnato type curve, Fig. 10 a EI Gamal type curve and Fig, "
'' T t a hockey stick type curve. Tha proximal. Intermediate and distil shaft , y , saations are as indicated. Th$ distil extremi#I$$ of ,~~h~ , ~ "
. ' , , :c catheters may be shaped before insertion into the patient's body by heating the catheter with a mandrel of the desired shape disposed within the inner lumen of the distal extremity so that the distal extremity will keep the shape of the mandrel when the catheter is cooled. If desired, control lines (not shown) may be incorporated into the wall of the catheter and extend out the proximal end of the catheter shaft, whereby when tension is applied thereto after the catheter is inserted into the patient, the distal extremity of the catheter shaft is deflected or shaped in a desired manner. These drawings are provided with reference numbers to as in Figs. 1 and 2.
Although individual features of embodiments of the invention may be shown in some of the drawings and not in others, those skilled in the art will recognize that individual features of one embodiment of the invention can be combined with any or all the features of another embodiment. Various modifications and improvements may be made to the present invention without departing from the scope thereof.
Claims (40)
1. A guiding catheter for directing an intravascular device within a patient's coronary sinus, comprising:
a) an elongated shaft having a proximal end, a distal end, a port in a distal tip of the shaft, and an inner lumen extending to and in fluid communication with the port in the distal tip which is configured to slidably receive the intravascular device;
b) a relatively stiff proximal shaft section of the elongated shaft;
c) a relatively flexible distal shaft section of the elongated shaft having a length of about 2.5 to about 15 centimeters and having a proximal portion having a flexibility greater than that of the proximal shaft section, and a nontraumatic distal portion having a flexibility greater than that of the proximal portion, at least a section of the lumen in the distal portion being axially aligned with the port in the distal tip of the shaft, and at least one of the portions of the distal section being shaped with a bend to facilitate entry within the patient's coronary sinus; and d) an adapter on the proximal end of the elongated shaft to provide access to the inner lumen extending within the elongated shaft.
a) an elongated shaft having a proximal end, a distal end, a port in a distal tip of the shaft, and an inner lumen extending to and in fluid communication with the port in the distal tip which is configured to slidably receive the intravascular device;
b) a relatively stiff proximal shaft section of the elongated shaft;
c) a relatively flexible distal shaft section of the elongated shaft having a length of about 2.5 to about 15 centimeters and having a proximal portion having a flexibility greater than that of the proximal shaft section, and a nontraumatic distal portion having a flexibility greater than that of the proximal portion, at least a section of the lumen in the distal portion being axially aligned with the port in the distal tip of the shaft, and at least one of the portions of the distal section being shaped with a bend to facilitate entry within the patient's coronary sinus; and d) an adapter on the proximal end of the elongated shaft to provide access to the inner lumen extending within the elongated shaft.
2. The guiding catheter of claim 1 wherein an expandable occluding member is provided on the distal section of the catheter shaft.
3. The guiding catheter of claim 2 wherein the expandable occluding member is an inflatable balloon.
4. The guiding catheter of claim 3 wherein the elongated catheter shaft has an inflation lumen extending therein from the proximal end to a location spaced proximally from the distal end and wherein the balloon has an interior which is in fluid communication with the inflation lumen.
5. The guiding catheter of claim 1 wherein the distal section of the elongated shaft has a length of about 5 to about 13 centimeters.
6. The guiding catheter of claim 1 wherein the proximal shaft section is formed of a polymer material having a hardness of about 60 to about 85 D (Shore).
7. The guiding catheter of claim 1 wherein the distal shaft section is formed of a polymer material having a hardness of about 80 A to about 60 D (Shore).
8. The guiding catheter of claim 1 including an intermediate section having a flexibility greater than the proximal shaft section and less than the distal shaft section.
9. The guiding catheter of claim 8 wherein the intermediate shaft section has a hardness of about 30 to about 60 D (Shore).
10. The guiding catheter of claim 8 wherein the intermediate shaft section has a length of about 1 to about 8 centimeters.
11. The guiding catheter of claim 8 wherein the intermediate shaft section has an expandable occluding member.
12. The guiding catheter of claim 11 wherein the expandable occluding member is an inflatable balloon.
13. The guiding catheter of claim 12 wherein the elongated shaft has an inflation lumen extending therein and the inflatable balloon has an interior in fluid communication with the inflation lumen.
14. The guiding catheter of claim 1 wherein the distal portion of the distal shaft section is formed of a polymer material having a hardness of about 80 A to about 20 D (Shore).
15. The guiding catheter of claim 1 wherein the proximal portion of the distal shaft section is formed of a polymer material having a hardness of about 30 D to about 60 D (Shore).
16. The guiding catheter of claim 1 wherein the distal section of the elongated shaft has a length of about 2 to about 7 centimeters.
17. The guiding catheter of claim 1 wherein the inner lumen is configured to slidably receive a guidewire therein.
18. The guiding catheter of claim 1 wherein the proximal section, proximal portion of the distal section, and distal portion of the distal section are formed of polymeric materials having different Shore Durometer hardnesses.
19. The guiding catheter of claim 1 wherein the port in the distal tip is directed away from a longitudinal axis of the proximal shaft section.
20. The guiding catheter of claim 1 wherein the port in the distal tip has a diameter equal to the diameter of the lumen.
21. An intravascular assembly including a) a guiding catheter for directing an intravascular device within a patient's coronary sinus, comprising:
an elongated shaft having a proximal and distal ends, a port in the distal end and an inner lumen extending to and in fluid communication with the port in the distal end, a relatively stiff proximal shaft section of the elongated shaft, a relatively flexible distal shaft section of the elongated shaft having a length of about 2.5 to about 15 centimeters and having a proximal portion having a flexibility greater than that of the proximal shaft section, and a nontraumatic distal portion having a flexibility greater than that of the proximal portion, and at least one of the portions of the distal section being shaped with a bend to facilitate entry within the patient's coronary sinus;
and an adapter on the proximal end of the elongated shaft to provide access to the inner lumen extending within the elongated shaft; and b) slidably disposed within the inner lumen of the guiding catheter, an intravascular device for detecting electrical activity of a patient's heart from within a cardiac vein thereof which includes an elongated shaft, a plurality of sensing electrodes on a distal extremity of the intravascular device and individual electrical conductors electrically connected to the sensing electrodes.
an elongated shaft having a proximal and distal ends, a port in the distal end and an inner lumen extending to and in fluid communication with the port in the distal end, a relatively stiff proximal shaft section of the elongated shaft, a relatively flexible distal shaft section of the elongated shaft having a length of about 2.5 to about 15 centimeters and having a proximal portion having a flexibility greater than that of the proximal shaft section, and a nontraumatic distal portion having a flexibility greater than that of the proximal portion, and at least one of the portions of the distal section being shaped with a bend to facilitate entry within the patient's coronary sinus;
and an adapter on the proximal end of the elongated shaft to provide access to the inner lumen extending within the elongated shaft; and b) slidably disposed within the inner lumen of the guiding catheter, an intravascular device for detecting electrical activity of a patient's heart from within a cardiac vein thereof which includes an elongated shaft, a plurality of sensing electrodes on a distal extremity of the intravascular device and individual electrical conductors electrically connected to the sensing electrodes.
22. The intravascular assembly of claim 22 wherein the intravascular device has a length greater than a length of the guiding catheter so that the proximal end of the intravascular device extends out the proximal end of the guiding catheter when the distal extremity of the intravascular device having sensing electrodes thereon extends out the distal end of the guiding catheter.
23. The intravascular assembly of claim 21 wherein the distal section of the elongated shaft has a length of about 2 to about 7 centimeters.
24. The intravascular assembly of claim 21 wherein the inner lumen is configured to slidably receive a guidewire therein.
25. A guiding catheter for directing an intravascular device within a patient's coronary sinus, comprising:
a) an elongated shaft having proximal and distal ends, a port in the distal end, a first inner lumen extending therein to a location proximal to a distal extremity of the shaft, and a second inner lumen extending to and in fluid communication with the port in the distal end;
b) a proximal shaft section of the elongated shaft;
c) a distal shaft section of the elongated shaft having a length of about 2.5 to about 15 centimeters and being shaped with a bend to facilitate entry within the patient's coronary sinus;
d) an expandable occluding member on the distal shaft section having an interior in fluid communication with the first inner lumen; and e) an adapter on the proximal end of the elongated shaft to provide access to the first and second inner lumens extending within the elongated shaft.
a) an elongated shaft having proximal and distal ends, a port in the distal end, a first inner lumen extending therein to a location proximal to a distal extremity of the shaft, and a second inner lumen extending to and in fluid communication with the port in the distal end;
b) a proximal shaft section of the elongated shaft;
c) a distal shaft section of the elongated shaft having a length of about 2.5 to about 15 centimeters and being shaped with a bend to facilitate entry within the patient's coronary sinus;
d) an expandable occluding member on the distal shaft section having an interior in fluid communication with the first inner lumen; and e) an adapter on the proximal end of the elongated shaft to provide access to the first and second inner lumens extending within the elongated shaft.
26. The guiding catheter of claim 25 wherein the expandable occluding member is an inflatable balloon.
27. The guiding catheter of claim 25 wherein the length of the distal section shaped with a bend is at least about 2.5 cm.
28. A guiding catheter for directing an intravascular device within a patient's coronary sinus comprising:
a) an elongated shaft having a proximal and distal ends, a port in the distal end and guidewire receiving lumen extending to and in fluid communication with the port in the distal end;
b) a relatively stiff proximal shaft section of the elongated shaft;
c) a relatively flexible distal shaft section of the elongated shaft having a length of about 2 to about 7 centimeters and being shaped with a bend to facilitate entry into the patient's coronary sinus;
d) an expandable occluding member mounted on the flexible distal section; and e) an adapter on the proximal end of the elongated shaft to provide access to the guidewire receiving lumen extending within the elongated shaft.
a) an elongated shaft having a proximal and distal ends, a port in the distal end and guidewire receiving lumen extending to and in fluid communication with the port in the distal end;
b) a relatively stiff proximal shaft section of the elongated shaft;
c) a relatively flexible distal shaft section of the elongated shaft having a length of about 2 to about 7 centimeters and being shaped with a bend to facilitate entry into the patient's coronary sinus;
d) an expandable occluding member mounted on the flexible distal section; and e) an adapter on the proximal end of the elongated shaft to provide access to the guidewire receiving lumen extending within the elongated shaft.
29. The guiding catheter of claim 28 wherein the elongated shaft has an inflation lumen extending from the proximal end to a location spaced proximally from the distal end and the expandable occluding member is an inflatable balloon having an interior in fluid communication with the inflation lumen.
30. The guiding catheter of claim 28 wherein the distal section of the elongated shaft has a length of about 3 to about 6 centimeters.
31. The guiding catheter of claim 28 wherein the proximal shaft section is formed of a polymer material having a hardness of about 60 to about 85D (Shore).
32. The guiding catheter of claim 28 wherein the distal shaft section is formed of a polymer material having a hardness of about 80A to about 30D (Shore).
33. The guiding catheter of claim 28 including an intermediate section having a flexibility greater than the proximal shaft section and less than the distal shaft section.
34. The guiding catheter of claim 33 wherein the intermediate shaft section has a hardness of about 30 to about 60 (Shore).
35. The guiding catheter of claim 33 wherein the intermediate shaft section has a length of about 1 to about 8 centimeters.
36. The guiding catheter of claim 28 wherein the relatively flexible distal shaft section includes a proximal portion having a flexibility greater than that of the proximal shaft section, and a nontraumatic distal portion having a flexibility greater than that of the proximal portion, wherein at least one of the portions of the distal section is being shaped with a bend to facilitate entry within the patient's coronary sinus.
37. An intravascular assembly including a) a guiding catheter for directing an intravascular device within a patient's coronary sinus, comprising:
an elongated shaft having a proximal and distal ends, a port in the distal end and a guidewire receiving lumen extending to and in fluid communication with the port in the distal end, a relatively stiff proximal shaft section of the elongated shaft, a relatively flexible distal section of the elongated shaft having a length of about 2 to about 7 centimeters and having a proximal portion having a flexibility greater than that of the proximal shaft section, and a nontraumatic distal portion having a flexibility greater than that of the proximal portion, wherein at least one of the portions of the distal section is being shaped with a bend to facilitate entry within the patient's coronary sinus;
an expandable occluding member mounted on the flexible distal shaft section; and an adapter on the proximal end of the elongated shaft to provide access to the guidewire receiving lumen extending within the elongated shaft;
and b) slidably disposed within the guidewire receiving lumen of the guiding catheter, an intravascular device far detecting electrical activity of a patient's heart from within a cardiac vein thereof which includes an elongated shaft, a plurality of sensing electrodes on a distal extremity of the intravascular device and individual electrical conductors electrically connected to the sensing electrodes.
an elongated shaft having a proximal and distal ends, a port in the distal end and a guidewire receiving lumen extending to and in fluid communication with the port in the distal end, a relatively stiff proximal shaft section of the elongated shaft, a relatively flexible distal section of the elongated shaft having a length of about 2 to about 7 centimeters and having a proximal portion having a flexibility greater than that of the proximal shaft section, and a nontraumatic distal portion having a flexibility greater than that of the proximal portion, wherein at least one of the portions of the distal section is being shaped with a bend to facilitate entry within the patient's coronary sinus;
an expandable occluding member mounted on the flexible distal shaft section; and an adapter on the proximal end of the elongated shaft to provide access to the guidewire receiving lumen extending within the elongated shaft;
and b) slidably disposed within the guidewire receiving lumen of the guiding catheter, an intravascular device far detecting electrical activity of a patient's heart from within a cardiac vein thereof which includes an elongated shaft, a plurality of sensing electrodes on a distal extremity of the intravascular device and individual electrical conductors electrically connected to the sensing electrodes.
38. The intravascular assembly of claim 37 wherein the intravascular device has a length greater than a length of the guiding catheter so that the proximal end of the intravascular device extends out the proximal end of the guiding catheter when the distal extremity of the intravascular device having sensing electrodes thereon extends out the distal end of the guiding catheter.
39. A guiding catheter for directing an intravascular device within a patient's;
coronary sinus, comprising:
a) an elongated shaft having proximal and distal ends, a port in the distal end and a guidewire receiving lumen extending to and in fluid communication with the part in the distal end;
b) a relatively stiff proximal shaft section of the elongated shaft, c) a relatively flexible distal section of the elongated shaft having a length of about 2 to about 7 centimeters and having a proximal portion having a flexibility greater than that of the proximal shaft section and a nontraumatic distal portion having a flexibility greater than that of the proximal portion, wherein at least one of the portions of the distal section is being shaped with a bend to facilitate entry within the patient's coronary sinus;
d) an intermediate section of the elongated shaft having a flexibility greater than the proximal shaft section and less than the distal shaft section, and having an expandable occluding member; and e) an adapter on the proximal end of the elongated shaft to provide access to the guidewire receiving lumen extending within the elongated shaft.
coronary sinus, comprising:
a) an elongated shaft having proximal and distal ends, a port in the distal end and a guidewire receiving lumen extending to and in fluid communication with the part in the distal end;
b) a relatively stiff proximal shaft section of the elongated shaft, c) a relatively flexible distal section of the elongated shaft having a length of about 2 to about 7 centimeters and having a proximal portion having a flexibility greater than that of the proximal shaft section and a nontraumatic distal portion having a flexibility greater than that of the proximal portion, wherein at least one of the portions of the distal section is being shaped with a bend to facilitate entry within the patient's coronary sinus;
d) an intermediate section of the elongated shaft having a flexibility greater than the proximal shaft section and less than the distal shaft section, and having an expandable occluding member; and e) an adapter on the proximal end of the elongated shaft to provide access to the guidewire receiving lumen extending within the elongated shaft.
40. The guiding catheter of claim 39 wherein the elongated shaft has an inflation lumen extending from the proximal end to a location spaced proximally form the distal end and the expandable occluding member is an inflatable balloon having an interior in fluid communication with the inflation lumen.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US48471595A | 1995-06-07 | 1995-06-07 | |
| US08/484715 | 1995-06-07 | ||
| PCT/US1996/009283 WO1996040342A1 (en) | 1995-06-07 | 1996-06-05 | Guiding catheter for coronary sinus |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2223990A1 CA2223990A1 (en) | 1996-12-19 |
| CA2223990C true CA2223990C (en) | 2007-01-30 |
Family
ID=23925299
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002223990A Expired - Fee Related CA2223990C (en) | 1995-06-07 | 1996-06-05 | Guiding catheter for coronary sinus |
Country Status (5)
| Country | Link |
|---|---|
| US (2) | US5775327A (en) |
| EP (1) | EP0836499A1 (en) |
| JP (1) | JPH11507251A (en) |
| CA (1) | CA2223990C (en) |
| WO (1) | WO1996040342A1 (en) |
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| US5195990A (en) * | 1991-09-11 | 1993-03-23 | Novoste Corporation | Coronary catheter |
| US5318032A (en) * | 1992-02-05 | 1994-06-07 | Devices For Vascular Intervention | Guiding catheter having soft tip |
| DE4205336C1 (en) * | 1992-02-21 | 1993-05-13 | Gsf - Forschungszentrum Fuer Umwelt Und Gesundheit, Gmbh, 8000 Muenchen, De | |
| US5242441A (en) * | 1992-02-24 | 1993-09-07 | Boaz Avitall | Deflectable catheter with rotatable tip electrode |
| US5306263A (en) * | 1992-05-01 | 1994-04-26 | Jan Voda | Catheter |
| US5706809A (en) * | 1993-01-29 | 1998-01-13 | Cardima, Inc. | Method and system for using multiple intravascular sensing devices to detect electrical activity |
| US5423772A (en) * | 1993-08-13 | 1995-06-13 | Daig Corporation | Coronary sinus catheter |
| US5488960A (en) * | 1994-04-11 | 1996-02-06 | Abbott Laboratories | Coronary sinus catheter introducer system |
| US5499973A (en) * | 1994-09-08 | 1996-03-19 | Saab; Mark A. | Variable stiffness balloon dilatation catheters |
-
1996
- 1996-06-05 JP JP9501637A patent/JPH11507251A/en not_active Withdrawn
- 1996-06-05 WO PCT/US1996/009283 patent/WO1996040342A1/en active Application Filing
- 1996-06-05 CA CA002223990A patent/CA2223990C/en not_active Expired - Fee Related
- 1996-06-05 EP EP96918250A patent/EP0836499A1/en not_active Withdrawn
-
1997
- 1997-05-19 US US08/858,297 patent/US5775327A/en not_active Expired - Lifetime
-
1998
- 1998-07-07 US US09/111,438 patent/US6021340A/en not_active Expired - Lifetime
Also Published As
| Publication number | Publication date |
|---|---|
| US6021340A (en) | 2000-02-01 |
| JPH11507251A (en) | 1999-06-29 |
| WO1996040342A1 (en) | 1996-12-19 |
| US5775327A (en) | 1998-07-07 |
| CA2223990A1 (en) | 1996-12-19 |
| EP0836499A1 (en) | 1998-04-22 |
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| Date | Code | Title | Description |
|---|---|---|---|
| EEER | Examination request | ||
| MKLA | Lapsed |